Swine flu patients at higher risk should get antivirals, but not others, government doctors say

Michael Probst/The Associated Press archiveHealth officials want to avoid overuse of Tamiflu and Relenza, because a virus can develop a resistance, making the drugs ineffective.

Most people who get swine flu don't need prescription flu drugs, nor do the "worried well," government doctors said Tuesday as they issued new guidelines for medicines in big demand.

The drugs Tamiflu and Relenza should only be used to treat people who are sick and at high risk for complications, federal health officials said.

The new advice tries to close a door that government doctors had left open with earlier guidance in May. Back then, they didn't rule out sometimes using the drugs to stop swine flu's spread and prevent illness even in children who had no symptoms.

But now the new flu is more widespread, including a new surge of cases in the Southeast and a large campus outbreak in the Northwest. And health officials say the antiviral medicines should be reserved for people at greater risk -- including pregnant women, children younger than 5, and people with certain chronic conditions such as asthma and heart disease.

"The majority of adolescents and adults and most children won't need antivirals," said Dr. Anne Schuchat of the Centers for Disease Control and Prevention, at a Tuesday news conference.

Swine flu was first identified in April and is now responsible for almost all flu cases in the United States. It has caused more than 1 million illnesses so far, though most were mild and not reported, the CDC estimates. Nearly 600 lab-confirmed deaths and more than 9,000 hospitalizations have been reported.

Six states have reported widespread flu cases, according to the government's most recent data. Most are in the Southeast, possibly because schools reopen for classes earlier in this region so there is more opportunity for the virus to spread among children. Flu-like illnesses last week led 25 schools in Alabama, Georgia, Missouri and Tennessee to dismiss students, affecting more than 12,000 pupils.

And in the Pacific Northwest, college officials said 2,000 Washington State University students were sickened by swine flu during the first two weeks of classes on the Pullman campus. None was hospitalized and the illnesses seem to be tapering off, officials said this week.

Overall, it's unclear whether swine flu is more dangerous than seasonal flu, which plays a role in an estimated 36,000 deaths each year. The virus has not mutated into a deadlier form since it first appeared, but health officials are concerned about the possibility.

Many parents are worried, too, leading to reported shortages of antiviral medicines in some parts of the country.

These prescription drugs, when started within two days after someone first becomes sick, can reduce flu symptoms and shorten the time of illness by one or two days.

The CDC recommends prompt treatment with Tamiflu or Relenza for anyone who is hospitalized with a flu-like illness, as well as treatment at the first sign of flu for high-risk people.

People older than 65 also should be given the drugs if they develop flu-like symptoms. Though the elderly have been less likely to catch swine flu, those who do get infected are more likely to become seriously ill, CDC officials said.

Health officials want to avoid overuse of Tamiflu and Relenza, because a virus can develop a resistance, making the drugs ineffective. The CDC said it's aware of only nine cases of Tamiflu-resistance in swine flu, and several were people who were taking the drug as a preventive rather than as a treatment.

Not surprising, said Dr. James Steinberg, an infectious diseases specialist at Atlanta's Emory University. "I would wager there's a lot of treatment going on in people outside the high-risk groups, based on clinicians' preference and patients' demand for treatment," he said.

There are side effects, including nausea or vomiting. Rare psychiatric problems have been reported in flu-infected children taking Tamiflu, mostly among adolescents in Japan. It's still not clear whether the drug or the virus was causing the problem, CDC officials said.